Poison or Prevention: Perceptions of Health Workers On Parental Vaccine Refusal in Metro Manila

PERPETUAL HELP COLLEGE OF MANILA
1240 V. Concepcion Street., Sampaloc, Manila 1008

SENIOR HIGH SCHOOL DEPARTMENT - JONELTA
Tel. Nos.: 7318199/7311550/7412681
POISON OR PREVENTION: PERCEPTIONS OF HEALTH WORKERS ON

PARENTAL VACCINE REFUSAL IN METRO MANILA
Abao, Kenji D.
Dela Cruz, Athur V.
Isidro, Khayie Nicole M.
Jacobe, Kresh Dhairyll P.
Longara, Dave Kyle A.
Robiños, Caselyn N.
Roja, Daphne Mae A.
Villar, Melody M.
SUBMITTED TO THE
IN PARTIAL FULFILMENT OF THE REQUIREMENTS

FOR THE BASIC EDUCATION DEPARTMENT
SENIOR HIGH SCHOOL
SCIENCE, TECHNOLOGY, ENGINEERING AND MATHEMATICS

(STEM) STRAND
MARCH 2019
1240 V. Conception St.,Sampaloc, Manila
Senior High School - JONELTA
Kenji D. Abao, Arthur V. Dela Cruz, Khayie Nicole M. Isidro, Kresh Dhairyll P. Jacobe, Dave Kyle A.
Longara, Caselyn N. Robiños, Daphne Mae A. Roja, Melody M. Villar
Perpetual Help College of Manila
Date of Submission
March 2019
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Kenji D. Abao, Arthur V. Dela Cruz, Khayie Nicole M. Isidro, Kresh Dhairyll P. Jacobe, Dave Kyle
A. Longara, Caselyn N. Robiños, Daphne Mae A. Roja, Melody M. Villar
This Senior High School undergraduate thesis titled, “Poison or Prevention: Perceptions of Health
Workers on Parental Vaccine Refusal in Metro Manila”, prepared and submitted by Ms. Khayie Nicole
M. Isidro and her group in partial fulfilment of the requirements for the Basic Education
Department – Senior High School, is hereby accepted.
AEGEAN PAUL RAMIREZ

Adviser
Accepted as partial fulfillment of the requirements for the Basic Education Department –
Senior High School.
MARIVIC TANEDO, MA.Ed.

Department Head, Senior High School
Tel. Nos.: 7318199/7311550/7412681
March, 2019
Marivic D. Tañedo
Department Head
Senior High School
Dear Dean Tañedo,
After having read the undergraduate thesis of Khayie Nicole M. Isidro and her group titled
“Poison or Prevention: Perceptions of Health Workers on Parental Vaccine Refusal in Metro Manila” and
after having made the necessary suggestions for improvement which were incorporated in
the final draft, I recommend that the undergraduate thesis be accepted in partial fulfilment of the
requirements for the Basic Education Department – Senior High School.
Sincerely yours,
AEGEAN PAUL RAMIREZ

Adviser
APPROVAL SHEET
Approved by the Panel of Examiners at the Oral Examination held on
_________________________ with a grade of _____________________________.
AEGEAN PAUL RAMIREZ

Adviser
MARIVIC D. TAÑEDO, MA.Ed.

Department Head, Senior High School
Khayie Nicole M. Isidro Dave Kyle A. Longara

Leader Member
Kenji D. Abao Caselyn N. Robiños

Member Member
Arthur V. Dela Cruz Daphne Mae A. Roja

Member Member
Kresh Dhairyll P. Jacobe Melody M. Villar

Member Member
BIOGRAPHICAL DATA
Name : Kenji D. Abao

Date of Birth : October 20, 2001
Place of Birth : Quezon City
Educational Attainment : Perpetual Help College of
Manila
Science, Technology, Engineering and Mathematics
(STEM)
2018-present
Balingasa High School
2014-2017
Balingasa Elementary School
2008-2014
Name : Arthur V. Dela Cruz

Date of Birth : January 30, 2002
Place of Birth : Damulog, Bukidnon
Educational Attainment : Perpetual Help College of
Manila
(STEM)
2018-present
Xavier de Damulog High School
2014-2017
Damulog Central Elementary School

2008-2014
Name : Khayie Nicole M. Isidro
Date of Birth : April 20, 2002
Educational Attainment : Perpetual Help College of Manila
(STEM)
2018-present
Ramon Magsaysay High School
Science, Technology, and Engineering (STE)
Special Science Curriculum
2014-2017
Andres Bonifacio Elementary School
2008-2014
Name : Kresh Dhairyll P. Jacobe

Date of Birth : June 15, 2002
Place of Birth : Manila, NCR
(STEM)
2018-present
The Family Clinic Inc. High School
2014-2017
Juan Sumulong Elementary School
2009-2015
Name : Dave Kyle A. Longara
Date of Birth : April 20, 2002
(STEM)
2018-present
High School Department
2014-2017
P. Gomez Elementary School
2008-2014
Name : Caselyn N. Robiños

Date of Birth : November 23, 2000
Place of Birth : Angeles City
(STEM)
2018-present
High School Department
2014-2017
Abundant Life School of Discovery

2008-2014
Name : Daphne Mae A. Roja
Date of Birth : December 21, 2001
Place of Birth : Occidental Mindoro
(STEM)
2018-present
Rizal National High School
2014-2017
Adela Elementary School
2008-2014
Name : Melody M. Villar

Date of Birth : September 28, 2001
Place of Birth : Manila, NCR
(STEM)
2018-present
Timoteo Paez Integrated High School
2014-2017
Timoteo Paez Elementary School
2008-2014
ACKNOWLEDGEMENT
The researchers would like to acknowledge and give thanks to the people who have played a
big role to fulfil this study.
We would first like to thank our Research Teacher Mr. Aegan Paul Ramirez of the Perpetual Help
College of Manila, for teaching and guiding the researchers all throughout the process of this
research. We would also like to acknowledge Dr. Benjamin M. Yson for approving our permit
letter to interview the health workers of Valeriano Fuguso Health Center District 3. And Mrs.
Marivic Tanedo for approving our research letter to conduct the study. Without their passionate
participation and input, the survey could not have been successfully conducted. And to the health
workers of Valeriano Fuguso Health Center District 3 for making time to answer our interview.
This study would not be possible without them.

DEDICATION
We would like to dedicate this work to Almighty God, our Creator for the blessings He had
bestowed upon us, for being our strength when we thought of giving up, for the guidance, strength,
power of mind and for a healthy mind and body all of these, we offer to you.
To our parents, who supported us all the way for the fulfilment of this research. They provided us
extra consideration with regards to time and money.
And lastly, to our beloved teacher, Mr. Aegean Paul Ramirez, who have been our mentor thank
you for telling us not to give up, for inspiring and believing in us.
ABSTRACT
The field of medicine has greatly improved since the ancient times. Nowadays, medical
technology has nanotechnology, vaccine, etc. Vaccine is one of the most major breakthroughs of
science because it helped eradicate disease such as smallpox and it even helped boost the immune
system of humans. Not only that, it is also the most effective tool against vaccine-preventable
diseases. Still some of the parents are questioning its safety because of lack of knowledge. The
researchers believe that in spite the fact that some parents refuse vaccination for their own
children, it is important to put their own safety first and their own health first. The aim of this
study is to know the perceptions of health workers about the parental vaccine refusal. The study
was conducted at Valeriano Fuguso Health Center District 3 which the respondents is the health
workers. Linear Snowball Sampling method was used in this study. Four health workers in
Valeriano Fuguso Health Center District 3 were included in our sample. The researchers designed
a semi-structured interview as their data collection instrument for this study. It was recommended
that if the future researchers continue this in a qualitative approach, they should have more
participants to make the study more reliable. And also it is recommended to make an action
research in this study.

TABLE OF CONTENTS
Chapter Page
I.…THE PROBLEM AND ITS SETTING…………………………………………….1
Introduction………………………………………………………………………..1
Statement of the Problem………………………………………………………….3
Objectives of the Study…………………………………………………….……...4
Theoretical Framework……………………………………………………………4
Conceptual Framework……………………………………………………………8
Scope and Delimitation…………………………………………………………....9
Significance of the Study………………………………………………………….10
Definition of Terms………………………………………………………..………10
II….REVIEW OF RELATED LITERATURE………………………………………..12
Literature Review……………………………………………………….………...12
III….METHODOLOGY…………………………………………………….…………19
Research Design and Sources of Data…...………………………………………19
Participants of the Study…………………………………………………………19
Instrumentation and Validation………………………………………………….20
Data Gathering Procedure……………………………………………………….20
Ethical Consideration……………………………………………………………21
Treatment and Analysis of Data…………………………………………………21
IV….PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA…….22
V….SUMMARY, CONCLUSION AND RECOMMENDATIONS………………..25
Summary of Findings…………………………………………………………..25
Conclusions…………………………………………………………………….26
Recommendations………………………………………………………………26
VI….REFERENCES…………………………………………………………………27
VII...APPENDICES…………………………………………………………………31
Tel. Nos.: 7318199/7311550/7412681
CHAPTER I
BACKGROUND OF THE STUDY
INTRODUCTION
Vaccine are among the most effective prevention tools in the clinical or hospital field.
According to Arbeter, A.M, Starr, S.E, and Plotkin, S.A. (1986), in their study about varicella
vaccine (also known as chickenpox vaccine) in healthy children and adults. They’ve used the Oka
strain of the vaccine and gives them to children and adolescents of 18 months of age and 16 years
of age with their parent consent and adults from 13 to 40 years of age participated in the study.
The study is about the effect of booster vaccine to the naturally immune subjects and to see if any
of the participants developed herpes zoster. It didn’t develop to any of the participants and their
data shows that the varicella vaccine is tolerated well by the participants but 5% to 10% of the
participants developed rashes which they think may contain virus and may lead to spread to
susceptible contacts. It also shows that previously immune individuals showed booster responses
to the vaccination. Chickenpox was prevented even after exposure of high dose of vaccine was
given three days within the exposure. This is just one study proving that vaccine is indeed the most
effective prevention tool in the medicine field.
Recently, there has been a decline on the number of parents taking vaccination for children.
According to Gatchalian S. (2018), The dengvaxia scare has caused of decline in parents getting
vaccinations for their children for their diseases such as flu, measles, polio and tuberculosis. She
also said that the coverage dropped to 49% for January 2018 from 89% in the same period last
year. On the report of Department of Health (DOH) the Philippines has one of the highest dengue
fatality rates in the world, with 732 deaths. The reasons vary widely between parents on to why
they are refusing vaccine for their children, but according to a study conducted Dubé, E. et. al.,
there are 4 categories are religious reasons, personal beliefs or philosophical reasons, safety
concerns, and a desire for more information from health care providers. Parental concerns about
vaccines in each category lead to a wide spectrum of decisions varying from parents completely
refusing all vaccinations to only delaying vaccinations so that they are more spread out. A large
subset of parents admits to having concerns and questions about childhood vaccinations. For this
reason, it can be helpful for pharmacists and other health care providers to understand the cited
reasons for hesitancy, so they are better prepared to educate their patients' families. Education is a
key player in equipping parents with the necessary information so that they can make responsible
immunization decisions for their children.
Between 2010-2016, vaccination rates rose 12% among Blue Cross health plan
members. But among 4.3% of children born in 2013, there was "documented parental
refusal" when pediatricians offered to vaccinate the infants. Unnervingly, that's a 70%
spike from the 2.5% rate of parental refusal that occurred in 2010. Children with nonmedical
exemptions are at increased risk for acquiring and transmitting vaccine-preventable diseases.
Other studies have also reported the importance of parents' concerns about vaccine safety when
they decide against vaccination. Clinicians and other health care providers play a crucial role in
parental decision making with regard to immunization. Health care providers are cited by parents,
including parents of unvaccinated children, as the most frequent source of information about
vaccination.
The use of vaccines dates back hundreds of years ago. Smallpox is one of the illness that
has been eradicated by vaccines because of this reason it saves approximately 5 million lives
annually (Children’s Vaccine Initiative, 1996). The medical technology has developed since then
and now, illnesses like measles, tetanus, and hepatitis B is now under control but it doesn’t mean
that such illnesses are eradicated.
Vaccines are important for immunization of disease although due to some cases that caused
controversy around vaccines. The number of parents accepting vaccines for their children declined
thus the increase of parental vaccine refusal increased. Recently in the Philippines, dengvaxia was
introduced but when the time it was implemented. Numerous deaths were reported due to the said
vaccine.
This study was conducted to know the perceptions of health workers about parental vaccine
refusal in the Metro Manila. This study aims to know the main factors that affected the decision
of the parents to refuse the take of vaccines for their child, to determine the negative effects of
parental vaccine refusal, to give any advice can they give to parents refusing vaccination for their
children, and to determine what they can do as a health worker to prevent this kind of situation.
STATEMENT OF THE PROBLEM
Vaccine refusal is of the issues that recently emerged in the Philippines because of the
reported cases of deaths that it caused. This study is conducted to know the perceptions of health
workers about parental vaccine refusal for their children.
This study also aims to answer the following questions:

1) What are the main factors that affected some of the parents’ decision to refuse taking
vaccines for their child?
2) What are the negative effects of parental vaccine refusal?
3) What advice can they as health workers give to parents refusing vaccine for their child?
4) What can they (health workers) do to prevent this kind of situation?
OBJECTIVES OF THE STUDY
The objective of the study is to know the perceptions of health workers about parental
vaccine refusal.
The aim of the study also involves the following:
1) To determine the main factors that affected some of the parents’ decision to refuse taking
vaccines for their child.
2) To know the negative effects of parental vaccine refusal.
3) To give advice to parents refusing vaccination for their children.
4) To know what they can do as health worker to prevent this kind of situation.
SIGNIFICANCE OF THE STUDY
This study hopes to understand the perceptions of health workers regarding the parental
vaccine refusal.
The following are the sectors who will benefit from the results of the study:
Students for them to be aware and to have knowledge about parental vaccine refusal which
is present in the Philippines.

Health workers for them to take steps in order to reduce the number of parents refusing to
take vaccinations for their children.
Parents for them to know the effects of parental vaccine refusal and to fully understand and
comprehend the situation when they refuse the take of vaccines.
Government for them to implement laws and programs regarding this situation.
Future researchers for them to continue this study or to use this research which will serve as
a secondary data for their study.
THEORETICAL FRAMEWORK
This study used the Social Judgment Theory by Carolyn Sherif, Muzafer Sherif, and Carl
Hovland. According to them there are three latitudes in which people contrast their personal
positions on issues to others’ positions around them. Also, according to this theory, every
individual compares their idea to others to determine if it’s acceptable or not. Aside from having
their own opinion, they also hold latitude of what they think is acceptable or unacceptable in accord
to another people’s view. One of the latitudes is the latitude of acceptance. This is the range of
ideas that a person sees as reasonable or worthy of consideration. Another is latitude of rejection.
This is the range of ideas that a person sees as unreasonable and objectionable. Last is the latitude
of noncommitment. This means that this is the range of ideas that person sees as neither acceptable
nor questionable.
necessary, but he/she knows that it is not to be questionable since he/she knows that vaccine is
effective. This kind of attitude will fall towards the latitude of noncommitment. This may cause
the parent to decide if he/she will vaccinate their child or not. Another example is that a parent is
health concerned person especially towards his/her own child so that parent will most likely to
accept vaccination for their children. This will fall down towards the latitude of acceptance because
that parent thinks that vaccination is acceptable and sees vaccination as effective and efficient.
Last example is that a parent thinks that vaccinating their children is not right because of his/her
religion beliefs, personal belief, or tradition that affected his/her decision to vaccinate their own
children. This kind of attitude falls down on the latitude of rejection because he/she thinks that
vaccination is unacceptable because of the reasons that affected his/her decision to vaccinate their
children.
Figure 1: Shows the concept diagram of Social Judgement Theory by Carolyn Sherif,
Muzafer Sherif, and Carl Hovland where in an individual judges an incoming message or
idea and there are three kind of latitudes for their attitude towards that idea.
It also used the Theory of Reasoned Action (ToRA or TRA) as theorized by Martin Fishbein
and Icek Ajzen. This theory explains the relationship between behaviors and attitudes within
human action. It is mainly used to predict how individuals will behave based on their pre-existing
attitudes and behavioral intentions. Their attitude towards behavior is affected by behavioral
beliefs and evaluation of behavioral outcomes while their subjective norms is affected by
normative beliefs. Both of this affects their behavioral intention which is their manifestation or
action towards a certain thing.
This theory is related to the study since there are reasons why an individual does an action or
decision. A person may decide or do something on what he thinks is right and acceptable. In the
study, it can be related to parents refusing vaccination for their children. For example, a parent
may have not decided to vaccinate their children early but knows that vaccine is effective against
vaccine-preventable disease.
Figure 2: Shows the concept diagram of Theory of Reasoned Action. It shows here the
factors that can affect a behavioral intention of a person and this will affect the behavior or
manifestation of an individual.
Last theory that was used for this study that can also be related to parents is Social Learning
Theory. This is theorized by Albert Bandura. As stated in this theory, cognitive factors,
environmental factors, and behavioral factors are correlated to each other and this determines
human behavior or learning. Cognitive factors are knowledge, expectations, and attitudes.
Environmental factors are social norms, access in community, and influence on others. Behavioral
factors are skills, practice, and self-efficacy. These factors can affect an individual especially on
their behavior.
This can be used on study because their knowledge about vaccination can greatly affect their
decision. Environmental factors can also affect parents’ decision because vaccine can be expensive
and is not accessible by all. There are schedules that are given to them, but they are not fully
committed to it. Parents are also easily influenced because of their peers and social norms.
Figure 3: It shows here the Social Learning Theory by Albert Bandura. It implies that
there are three factors that can affect the human behavior or learning skill of a person. These
are cognitive (personal) factors, environmental factors, and behavioral factors.

CONCEPTUAL FRAMEWORK
Religion Personal Safety Desire for Environmental

Reasons Beliefs Concerns More Factors
Information
Vaccine Vaccine
Hesitancy Efficacy
reasons, personal beliefs or philosophical reasons, safety concerns, and desire for more
Health
Workers Parents Children Community
Figure 1: Shows the factors why parental vaccine refusal is present. It is also shown
here that vaccine hesitancy and vaccine efficacy is correlated to parental vaccine refusal.
The ones that are affected of this issue are mainly health workers, parents, children, and
community.
The main factors that can affect a parent’s decision whether to take vaccination for his/her
children consists of religion reasons, personal beliefs, safety concerns, desire for more
information, and environmental factors that is based from the study of Dubé, E. et. al. This
explains why the attitude of some parents are different to majority is because if these factors.
Vaccine hesitancy is correlated to parental vaccine refusal because vaccine hesitancy is almost
the same as parental vaccine refusal, but the difference is that parents are hesitant but still has
a tendency of vaccinating their children whereas parental vaccine refusal is completely refusing
vaccination. Vaccine efficacy is also correlated to parental vaccine refusal because some
parents still questions the efficiency and effectiveness of vaccine. The people who are affected
of this issue are health workers, parents, children, and community.
SCOPE AND LIMITATIONS
This study aims to investigate the perceptions of health workers about parental vaccine
refusal. The researchers also want to know the other factors and effects of parental vaccine
refusal. The subject of this study will only be composed of health workers here in the Metro
Manila specifically in district 3 and their perception about parental vaccine refusal. This study
will only focus on vaccines only and will not have any specifics.
The participants of this study will consist of health workers from the health center
specifically from Valeriano Fuguso Health Center District 3 aged 28-45 years old. The nature
of the study used is qualitative approach and the method used is an in-depth semi-structured
interview with each individual using recording materials such as sound recorder or a camera
which will help the researchers in gathering information given if they allowed the proponents
to record them.
This study will only be limited to perceptions of health workers regarding parental
vaccine refusal in Metro Manila because the researchers had participants from the selected
health center in district 3. It will only be limited to health workers only and their standpoint on
the said issue. It is also limited to vaccines in general. In addition, it only focuses parental
vaccine refusal that is a prominent issue on the Philippines and does include other working in
the medical field such as nurses, doctors, and etc.

DEFINITION OF TERMS
• Vaccine - a preparation of killed microorganisms, living attenuated organisms, or living
fully virulent organisms that is administered to produce or artificially increase immunity to
a particular disease.
• Health workers – people whose job it is to protect and improve the health of their
communities. Together these health workers, in all their diversity, make up the global health
workforce.
• Parental – comes from the word parents that means a person who brings up and cares for
another.
• Vaccine Refusal - to refuse the take of vaccine.
• Parental Vaccine Refusal - parents who refuse to take vaccines for their children due to
misconceptions about vaccination.
• Clinical Impact - also known as clinical significance which means the practical importance
of a treatment effect whether it has a real genuine, and noticeable effect on daily life.
• Measles – a highly contagious disease caused by the measles virus. An infected individual
develops a small spot and has cough, runny nose, and inflamed eyes.
• Polio - also known as Poliomyelitis. An infectious disease caused by polio virus. An infected
individual can have muscle weakness resulting in an inability to move. The weakness most
often involves the legs but may less commonly involve to the muscle to the head, neck, and
diaphragm.
• Smallpox – smallpox is an extremely contagious and deadly virus for which there no known
cure. This disease has been completely eradicated.
• Dengvaxia - a vaccine developed to increase the immunization of children to the illness
known as dengue fever.

• Religious Reasons - one of the factors that affects parental vaccine refusal. This reason is
mainly about religion.
• Personal Beliefs - one of the factors that affects parental vaccine refusal. This reason is about
an opinion of a parent or an individual.
• Safety Concerns - one of the factors that affects parental vaccine refusal. This reason is about
questioning the safety of vaccine for children.
• Desire for More Information - one of the factors that affects parental vaccine refusal. This
reason is about the knowledge of parents about vaccination.
• Environmental Factors - one of the factors that affects parental vaccine refusal. This reason
can affected by peer influences, social norms, and access in community.

CHAPTER II
REVIEW OF RELATED LITERATURE
This section talks about the related studies and literature that are connected
and in line with the study that is conducted. The proponents used themes to divide the
literature and studies in accordance to their context for better understanding.
VACCINE EFFICACY
According to Arbeter, A.M, Starr, S.E, and Plotkin, S.A. (1986), in their study
about varicella vaccine (also known as chickenpox vaccine) in healthy children and
adults. They’ve used the Oka strain of the vaccine and gives them to children and
adolescents of 18 months of age and 16 years of age with their parent consent and adults
from 13 to 40 years of age participated in the study. The study is about the effect of
booster vaccine to the naturally immune subjects and to see if any of the participants
developed herpes zoster. It didn’t develop to any of the participants and their data shows
that the varicella vaccine is tolerated well by the participants but 5% to 10% of the
participants developed rashes which they think may contain virus and may lead to
spread to susceptible contacts. It also shows that previously immune individuals often
show booster responses to the vaccination. Chickenpox was prevented even after
exposure of high dose of vaccine was given three days within the exposure.
In addition, as stated by Gross, P. A, et. al. (1995), in their research the efficacy of
influenza vaccine in elderly persons which aims to quantify the protective efficacy of
influenza vaccine in elderly persons. Their data shows that vaccine efficacy in case-
control studies ranged from 32% to 45% for preventing hospitalization for pneumonia
and from 31% to 65% for preventing hospital deaths from pneumonia and influenza.
Their study confirmed that influenza vaccine reduces risks for pneumonia and death in
elderly persons during an influenza epidemic if the vaccine strain is identical or similar
to the epidemic strain.
STATISTICS OF VACCINATION IN THE PHILIPPINES (2017-2019)
According to Silva M. (2018), the manager of DOH National Immunization
Program. Many parents are still unwilling to have their children immunized in their
various vaccination programs. She said the “very low (vaccination) coverage for most
regions” in the Philippines has resulted in several outbreaks for preventable diseases
such as measles in early 2018. She also added, because of the controversies by the
dengue vaccine, “we can’t move forward.”
In February 2018, Health Undersecretary Enrique Domingo stated that only
60% of children were getting their scheduled vaccines. The DOH annual vaccination
rate target is between 85% to 90%. A few months later, Domingo said “We haven’t hit
90%, our coverage now is still about 50 to 60%.”
Silva also hoped that over time, it would be the norm that mothers have their
children vaccinated because it’s a child’s right to be protected from vaccine-preventable
diseases and with accordance to this, World Health Organization (WHO) (2015) stated
that people who are delaying are refusing vaccine for themselves or for their children
are presenting a growing challenges for countries to close the immunization gap.
Many parents still refuse or hesitant to vaccine their children because of the fear of
dengvaxia issue and others have their own reasons why they didn’t vaccinate their
children. The vaccination rate becomes lower and didn’t reached the target.
REPORTED OUTBREAKS OF VACCINE-PREVENTABLE DISEASES IN
THE PHILIPPINES
The goal of Vaccine Preventable Disease surveillance is to improve the capacity
of the health system to prevent and control trough timely detection and appropriate
response to vaccine preventable diseases with high level of morbidity, disability, and
mortality. A total of 4, 492 suspect measles-rubella cases were reported from January
1 to March 31, 2018. From January to March 2018, cases are 3.5 time as high as the
number of cases reported during the same time period last year. There were 761
confirmed measles cases with 14 deaths and in 2018 it increased 41 times compared to
the same period in 2017. Majority (403, 53%) of the confirmed measles cases were
males and ages group with the greatest number of cases were 1-4 years old (299, 39%),
less than 9 months old (171,22%) and 9-11 months old (67, 9%). Majority (612, 80%)
of the confirmed measles cases were not vaccinated, vaccinated with unknown no. of
doses (130, 17%). The top reasons for non-vaccination of measles-containing vaccine
among confirmed cases were not eligible for vaccination (28%), mother was busy
(20%), child was sick (16%) and other reasons like moves residence, parents refused or
lack of knowledge. There were 14 deaths out of the 761 confirmed measles cases. Most
(10, 71%) of the deaths had pneumonia complications.
VACCINE HESITANCY
One of the factors why parental vaccine refusal is present is vaccine hesitancy
because of the doubt of the parents for their children safety for vaccination. Vaccine
hesitancy is when a parent questions the effectiveness of vaccine and it is when a parent
is hesitant to his/her decision whether to vaccinate their own children or not. According
to Dubè, E. et. al. (2013), vaccine hesitancy is believed to be responsible for decreasing
vaccine coverage and it also increases the risk of vaccine-preventable diseases
outbreaks and epidemics. Their study identifies the possible causes of vaccine hesitancy
of parents and the determinants of individual-decision making about vaccination. The
potential causes of vaccine hesitancy as stated in their study are the importance of the
historical, political and socio-cultural context. Their definition of determinants of
individual-decision making is not definitive but it is influenced by their knowledge,
past experiences, perceived importance of vaccination, trust, subjective norm, religious
convictions, and moral convictions. It can also be influenced by environmental factors
such as communication and media.
In a research article by Kennedy, A. et. al. (2011) they investigated parents’
perceptions and found out that even though the parent’s received vaccinations for their
children, they still have concerns, questions, and misconceptions about them. Some of
the concerns reported by parents are children are getting too many vaccines/ too many
shots are painful for their children, vaccine may cause illness, the ingredients in
vaccines are unsafe, and vaccines are given to prevent diseases they are not likely to
get. Only 23% of the parents had no concerns about vaccines.
It is also important to bridge the trust of the parents to take vaccination for their
children. The study conducted by Larson, H. J, et. al. (2011), discuss the characteristics
of the changing global environment that are contributing to increased public
questioning of vaccines and to know the specific determinants of public trust. They
stated that it is neither driven by scientific nor economic evidence alone. It is driven by
mix of psychological, sociocultural, and political factors. The trust of parents still
depends on their perceptions on vaccines itself. But scientifically based evidence on the
risk-benefit ratios of vaccines is crucial it is not enough to make up the gap between
current levels of public confidence in vaccines and levels of trust needed to sustain
vaccine coverage needed.
Many children do not receive life-saving immunization and 1.5 million of them
die. According to World Health Organization (WHO) one out of five of children die
annually from the viruses could prevented by vaccines that exist. The WHO guest-
edited the special issue in journal vaccine, the role of vaccines hesitancy to limit the
vaccine the coverage of number of studied and review experts. “To delay in acceptance
or refusal of safe vaccines despite availability of vaccination services” defined as the
vaccine hesitancy. The senior health adviser for WHO’s Immunization, Vaccines, and
Biological Department. Ducloswas a guest editor of special issue, entitled “WHO
recommendations regarding vaccine hesitancy.” Dr. Philippe Duclos said “Vaccines
can only improve health and prevent deaths if they are used, and immunization
programs must be able to achieve and sustain high vaccine uptake rates. Vaccine
hesitancy is an increasingly important issue for country immunization programs.” The
factors influence such as misinformation, complacency, convenience and confidence,
the WHO said. “Vaccines can only improve health and prevent deaths if they are used
it, the issue is complex and context specific, varying across time, place and vaccines.
PARENTAL VACCINE REFUSAL
Parental vaccine refusal is often associated to vaccine hesitancy, but it is a different
context. It refers to completely refusing the take of vaccination while vaccine hesitancy
refers to the doubt in vaccine, but a parent has still a tendency to take vaccination for
their children. In a study conducted by McKee, C, and Bohannon, K. (2016) is almost
similar to the article made by Dubè, E. et. al. which identified the causes of vaccine
hesitancy. In their study, they had four categories which includes religion reasons,
personal beliefs or philosophical reasons, safety concerns, and desire for more
information from healthcare providers. They also stated here that education is the key
player when it comes to this kind of issue. Parents should always ask and understand
the benefits of vaccination without feeling attacked and judged for having a question
about their children’s healthcare. Also, healthcare providers should speak of this on a
more relatable level and to speak to the areas patients values the most.
In another study by Omer, S.B, Salmon, D.A, Orenstein, W.A, et. al. (2009) states
the risks of vaccine-preventable disease and tells the factors why vaccine refusal is
present. According to them, United States implemented mandatory immunization as a
school requirement to reduce the case of vaccine-preventable disease such as measles.
Moreover, children with nonmedical exemptions are at increased risk for acquiring and
transmitting vaccine-preventable disease. It is also presented here that vaccine refusal
is one of the risk factors for the increase of measles outbreaks in the United States. The
reported number of cases dropped from an average of 500,000 annually. In fact, vaccine
refusal does not only increase the risk of disease of an individual but also the whole
community.
Furthermore, according to Salmon and Moulton (2005), in general, the most
common reason for the rejection of taking vaccine for their children is the parental
beliefs about the effects of vaccine and the possible dangers of contracting diseases.
More specifically, most parents of exempt students worry about the unknown effects of
vaccine, side effects and reaction with their other conditions and medical issues. But
according to Ward, et. al. (2017), there are many alternative methods of preventing
diseases aside from vaccination which has a lesser risk of contracting diseases. They
also stated that maintaining their lifestyle would help in reducing the risk from diseases.
In another study by Dubè, E., Vivion, M., and MacDonald, N. E. (2014) vaccination is
preserved as unsafe and unnecessary by a growing number of parents. Anti-vaccination
has been implicated in lowered vaccine acceptance rates and in the increase in vaccine
preventable disease outbreaks and epidemics.
In a case study conducted by Chootingpongchiaviat, S. et. al. (2016), all issues that
are brought up these days about vaccination must not be the reason to be scared nor
confuse parents of getting vaccinated. People must set aside the negativity of the issues
or else it will be the cause of regret in the future.
Most of the findings in the studies that are related to this research, it shows that
vaccine is effective and efficient. It helped lower the risk of being exposed to vaccine-
preventable disease and even showed booster effects from the vaccine. To statistics that
were shown, it is due to the dengvaxia scare and lack of knowledge about vaccine is
the cause why the coverage for vaccine in the Philippines decreased. Due to this,
measles cases increased. It is also presented here that vaccine hesitancy is affected by
factors like historical, political, and socio-cultural context. Vaccine hesitancy can
contribute to parental vaccine refusal. In the literature presented here, it is showed that
parental vaccine refusal can affected by factors such as religion reasons, personal
beliefs, safety concerns, and desire for more information.

CHAPTER III
METHODOLOGY
RESEARCH DESIGN
This study uses a qualitative approach and a descriptive type of research design because it
deals with the narratives of the participants and each of the participants will tell their own
perceptions or experiences regarding the parental vaccine refusal which is a prominent issue
present in the Philippines. The response given by the participants are their description of their
experiences in their field of work.
SOURCES OF DATA
The data will come from the narratives of the participants that participated in the interview
conducted in the study which are health workers. It comes directly from the health workers
which is a primary source of data. The secondary source of data will be coming from documents
that came from the internet such as news articles, and journals.
PARTICIPANTS OF THE STUDY
The participants of the study are health workers from health center specifically from
Valeriano Fuguso Health Center District 3. The study will be comprised of 4 participants. The
participants are qualified to participate in the study because they play an important role on
reminding parents for vaccination of their children and their experiences or perceptions about
the parental vaccine refusal is used as a data of the study. The participants’ qualifications are
aged 28-45 and should have at least 5 years of experience in their field of work because they
are experienced, and they are professionals in this kind of work.

INSTRUMENTATION AND VALIDATION
The instrument of the study is in a form of semi-structured interview. The proponents of
the study used linear snowball sampling to find participants for the conducting this research.
The data collected from the participants is in a narrative form and it is transcripted. The
questions that were used for the interview are validated by Sir Aegean Ramirez, the research
adviser of the proponents. The following are the questions that will be asked during the
interview.
1.) What are your experiences as a health worker that you think affected parent’s decision
in vaccinating their own children?
2.) Why do you think parents are refusing vaccination for their children? Do you think
that factors like peer influence, personal reasons, religion, tradition, and
environmental factors can affect their decision to vaccinate their children? If so, why?
3.) What can be the clinical impact of parents refusing vaccination for children?
4.) As a health worker, what can you do to prevent this kind of situation? Do you think it
is necessary for mandatory vaccination for children as a school requirement?
5.) Any advice that you can give to the parents who are refusing vaccination for their
children?
DATA GATHERING PROCEDURE
In conducting the study, the proponents conducted an interview to a selected health center
in which there will be 4 participants. The participants are health workers who have experiences
in raising awareness for vaccination of children. Firstly, the proponents of the study constructed
interview questions that will be needed for data gathering. Secondly, one of the researchers
gained access to the selected health center which is Valeriano Fuguso Health Center in District
3 and established rapport to the people who are present there to build comfort and trust in
between the researchers and the participants. Thirdly, the proponents asked for permission and
consent to conduct an interview in the health center to the district office. The researchers
created request form that is needed for the city hall permit which will be important to properly
conduct an interview to the selected health center since the issue to be tackled is quite sensitive.
They gave the participants a consent form saying that they are willingly to give out answers
given that it will be treated with utmost confidentiality. Lastly, the proponents conducted an
in-depth semi-structured interview with the health workers. Two out of four of the participants
preferred to go together with the interview since they are not comfortable talking about it alone
and also decided to not record their responses, instead the researchers wrote down their answers
to keep their privacy. The response of the participants of the study is transcripted into a
narrative. The data gathered is analyzed through thematic analysis in which all the response
given of the health workers with same contexts is generalized into a theme so that it can be
easily interpreted as data.
ETHICAL CONSIDERATION
The data gathered will be treated in utmost confidentiality. This study will also build a
respect for intellectual property and the study will observe objectivity while conducting the
study. Before conducting the study, the researchers of the study asked permission from the city
hall and from the health center as well. The participants have a formal consent in order to
participate in the study. The proponents will also be honest and open to the information given
by the participants. The participants signed a consent form, agreeing that they are willing to
participate in the study and they are willing to give out answers that will be given by the
researchers.
TREATMENT AND ANALYSIS OF DATA
Based on the research approach that is used in the study, the data gathered from the
participants which are narratives. The data is analyzed through thematic analysis. The
narratives of the health workers with same context will be further explained with a theme in
connection to their response. The response gathered from the narratives of the health workers
is generalized, transcripted, and used as a primary basis of data for creating a theoretical
standpoint that will lead to the supporting conclusion towards the issue of this study.
CHAPTER IV
PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA
This chapter presents the data gathered from the participants. It also analyzes the data
through thematic reflection. The proponents will also interpret the data in this section.
Thematic Reflection
PREVENTION
Participant A is a health worker in V. Fuguso Health Center District 3. According to
her, her experiences as a health worker is the issue about the dengvaxia because many parents
still hesitant to vaccinate their children. As she stated, “Experience sa ngayon yung dengvaxia
hanggang ngayon naano pa rin sila sa mga injection hindi dengvaxia kasi inano na nila ang
pangkalahatang group kaya tuloy pag nag-booster kami kagaya ng tigdas parang nag-aalangan
sila magpabakuna kasi dahil dun sa isyu ng dengvaxia.” She also added that whenever we give
booster vaccine to them (parents) such as measles vaccine. They are hesitating whether to
vaccinate their children because of the dengvaxia scare that happened last year. She also said
“Oo naman kasi kailangan natin ng bakuna eh at sobrang maapektuhan talaga yung kalusugan
ng bata kasi nga di siya nagpabakuna at ito yung magiging dahilan kung bakit mas lalong
nagkakasakit yung bata ng mga sakit na kayang maiwasan dahil sa bakuna.” She agreed that
there is an effect for the child’s health because there are diseases that can prevent through the
vaccination and if the children are not vaccinated this will be the reason why the children are
exposed to vaccine-preventable disease. To prevent this kind of situation is that they encourage
the parents and give lectures to have a better understanding about vaccination. In which she
told the researchers “Encourage saka pagbibigay ng lecture sa barangay para mas maunawaan
nila.” She also agreed to the mandatory vaccination as a school requirement. She also added
“Ano lang sa pagka sa information dissemination pag hindi mo napabakunahan yung anak,
katulad sa tigdas sa sampung batang binakunahan sa lugar niyo. Yung isa pag hindi
nababakunahan at nagkaroon ng tigdas yun lang ang mamamatay kaya talagang kailangan na
kailangan yung bakuna.” In the information dissemination if you did not vaccinate your
children like measles vaccine. Out of 10 children that are being vaccinated within that vicinity
if there is one that is not vaccinated, she/he will be the only who is most likely to die that is
why vaccination is very important. Participant B is also a health worker from the same health
center, she stated that “Sa totoo lang, naglelecture kami eh. Nagbibigay kami ng ISC materials
talagang nagaano kami sa barangay minsan may mga kasama kaming hepo yan mga nurse
namin kung may bagong programa ang Manila Health Department o ang Department of Health
inaano namin yan tinuturo talaga namin yan, nagbibigay kami ng flyers mga ganun para aware
sila.” They give lectures whenever there are new programs implemented by the Department of
Health and they also give flyers to raise awareness that parents need to vaccinate their children.
Similar to the statements of Participant C which she told the interviewer “Ang ginagawa namin
ay nagbabahay bahay talaga nang sa ganun ay aware sila lalo na kapag may libreng bakuna ang
DOH at nagkakaroon ng mga information campaign sa barangay.” They do door-to-door for
parents to let them know that whenever free vaccination is available they tell parents. Same
goes with Participant D that stated “Naglilibot kami sa barangay na inassign samin then
namimigay kami ng flyers. Binibigyan namin sila ng ganon para aware sila. Nangangatok kami
sa mga bahay bahay na nasasakupan namin tas tatanungin namin if complete ba sa vaccine
yung anak nila, and pag hindi pa binabakunahan ng nurse na kasama namin yung bata kung
ano yung kulang.” Which is similar to the statement of Participant C that they do door-to-door
to parents to remind them of their schedules and if their child has complete vaccination so that
their nurses can vaccinate them if they are not yet vaccinated.
It is shown in their responses that they do their work as health workers to prevent
parents from refusing vaccination. They do door-to-door to remind parents of their schedules
for vaccination. They also give out flyers to raise awareness that vaccine is important for their
children. They also carry out seminars and programs that is free to attend for parents if they
have questions and concerns regarding vaccination.
PROTOCOL
Participant B is a health worker in V. Fuguso Health Center District 3. She is 30 years
in service. She said that “Actually, naman tinatanggap nila yan. Ito lang mga late yung
nagkaron tayo ng tungkol sa dengvaxia kaya sila natakot pero simula’t sapul mula tayo nung
mga bata pa kami may mga bakuna na talaga at saka hindi sila apektado talagang
pinapabakunahan nila yung mga anak nila kasi alam naman nila simula’t sapul ang bakuna
pagkapanganak ng bata mula pa naman nagbubuntis yan pagpunta nila dito inaadvice na sila
na pagnanganak sila ganito papabakunahan. Ano nga eh pagkalabas ng bata diba BCG na agad
yun, nilalagyan agad ng hepagon talagang ano yun kumbaga yun na talaga ang patakaran ng
hospital na pagkapanganak babakunahan na agad ang bata, wala naman nanay na nagrerefuse
na pabakunahan sila kasi kailangan talaga.” Her experiences as a health worker is that since
birth, we have vaccination and parents are obliged to vaccinate their children because they were
aware of the vaccine since her pregnant and when they gave birth they are advice to vaccinate
their child. She added that when the baby is born, they give a vaccine like BCG because it is
the hospital’s policy and there is no mother who refuses to vaccinate their children because
they really need that. Participant C stated that “Actually, lagi naman nagpapabakuna ang mga
bata kasama ang kanilang mga magulang, yun nga lang dahil sa issue about dengvaxia
nagkaroon sila ng pag-aalangan na magpabakuna.” Parents are always vaccinating their
children but because of the dengvaxia issue they had concerns they became hesitant about
vaccine. Participant D added that “Dahil din siguro sa issue nung mga nakaraan lang like
measles outbreak and dengvaxia pero hindi naman sila naapektuhan ng sobra kasi kailangan
talaga ng mga anak nila magkabakuna kasi simula bata pa lang required nang magpabakuna
ang mga anak nila. Sa hospital palang pinapaalala na ng mga doktor sa mga nanay
pinagbubuntis pa lang nila yung bata.” It is because of the recent measles outbreak and
dengvaxia which is the cause of parents refusing vaccination for their children, but it is required
that mother should accept vaccine for their baby and their doctors remind them that it is
important.
The data gathered from the participants implies that ever since birth it is a protocol for
parents to vaccinate their children because it helps boost the immune system of a child and
helps prevent diseases such as measles in which babies are prone of catching it because their
immune system are not strong enough to prevent it.
FOR THE BETTER GOOD
Participant C is a health worker in V. Fuguso Health Canter District 3. She is 5 years
in service. She said that “Actually, lagi naman nagpapabakuna ang mga bata kasama ang
kanilang mga magulang. Yun nga lang dahil sa issue sa dengvaxia nagkaroon sila ng pag-
aalangan na magpabakuna ulit.” Her experience is many parents are willing to vaccinate their
children but after the issue about the dengvaxia they are now hesitant. She also added “May
epekto yun kasi kailangan talaga ng bata ang bakuna para maprotektahan siya sa mga diseases.”
There are effects in the health of child when they are vaccinated, and it is important to protect
them from diseases. Participant C agreed to the mandatory vaccination as a school requirement.
She also give advice to parents that refused vaccination “Ano lang, isipin nilang para sa
ikakabuti iyon ng bata at makinig sa mga campaign or lectures ng barangay about sa
vaccination ng mga bata.” Her advice to the parents who still didn’t vaccinate their children,
think that it’s for the safety of their child and attends their lectures or campaign about
vaccination. Participant B told the interviewer that “Yun nga nagpupunta kami sa kanila nag
lelecture kami actually, nagpatawag kami sa lahat ng chairman para nga dito sa cervical cancer
vaccine kasi pag sa private mo yan mahal kasi pero ngayon nagbigay nga actually ano yun St.
Francis French siya na kumbaga na private siya.” Her advice is they should listen to seminars
and lectures given by their barangay so that they will know the importanct of vaccine and she
also said that they give free cervical cancer vaccine in which when they will avail at private
sectors it costs thousands of pesos. Participant D added that “Isipin na lang yung mas ikabubuti
sa bata tsaka kung gusto niyong hindi magkasakit ang anak niyo ipabakuna niyo sila. Para din
‘to sa mga magandang kinabukasan nila and maging healthy sila.” Her advice is that parents
should think that it is for the better good of their own children and for their children to not
develop vaccine-preventable disease. It can also make their children healthy and betterment of
their future.
Based from their narratives, vaccination can do good to the children because it helps
boost their immune system and even make their children healthy. This can cause their children
to do better at all aspects of their life and parents should do effort for their children so that they
will provide better future for them by making their children healthy and vaccine-preventable
disease free.
PERSONAL BELIEFS, RELIGION, AND PEER INFLUENCES

Participant D is a health worker form V. Fuguso Health Center District 3. She is 29
years old and 10 years in service. She said that “Dahil din siguro sa issue nung mga nakaraan
lang like measles outbreak and dengvaxia pero hindi naman sila naapektuhan ng sobra kasi
kailangan talaga ng mga anak nila. Sa hospital pa lang pinapaalala na ng mga doktor sa mga
nanay pinagbubuntis palang nila yung bata.” Her experiences as a health worker that affect
parents decision is that because of the issue about the measles outbreak and dengvaxia and it
is required for children to be vaccinated and Doctor advises mothers to have their children
vaccinated. She also added “May mga ganung religion dito sa bansa natin pero most of the time
mas nananaig pa din yung kagustuhan nila magpabakuna. Syempre madaming Catholic and
mga iba pang religion na hindi naniniwala sa ganon. Pero yung mga muslim yung iba talaga sa
kanila magpabakuna yung iba dahil sa paniniwala nila kasi against religion nila yon at
kinaugalian na nila.” Factors like peer influence, personal reasons, religion and traditions etc.
can affect their decision because others have their own beliefs and also it has effect on the
health of children when they are not vaccinated. Participant C also agreed to this statement “Oo
nakaaapekto yun dahil minsan dahil sa kanilang relihiyon kaya ganun katulad ng sinabi ng mga
kasamahan ko yung sa Muslim dahil nga sa relihiyon nila.” It is mainly because of religious
reasons why parents are refusing vaccination for their children. Participant B also stated that
“Oo totoo yun kagaya ng mga muslim, yung iba ayaw talaga na pinababakunahan yung bata
kasi nga against sa religion nila yun ganun talaga talaga kinaugalian na yun na meron talagang
ganun pero sa ating mga Catholic saka millennials na ngayon eh talagang level up na diba pag
talagang ipinanganak ang bata pinapabakunahan na talaga alam na nila yun meron na sila
kumbaga alam na nila yan ang pagpapabakuna sa bata ay kailangan na gawin.” She agreed that
it is also mainly of religous reasons and environmental factors is the main cause why parents
are refusing vaccination.

Based from the data gathered, the main reasons why parents are not vaccinating their
children is because of the dengvaxia issue, religious reasons, personal beliefs, safety concerns,
and environmental factors. These are the reasons why parental vaccine refusal is present and
the ones that are affected are health workers, parents, children, and the community.
CHAPTER V
SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS
Summary of Findings
Parental vaccine refusal is when a parent refuses a vaccine for his/her children. This
research is a qualitative study that uses the descriptive type of research. It deals with the
narratives of the health workers who participated in the interview.
The participants of this research came from Valeriano Fuguso Health Center District 3.
The researcher interviewed four participants aged 28-45 years old. The researchers used a semi-
structured interview guide that would tell about their perceptions, experiences, and advices.
The researchers found out that mainly because of safety concern is the reason why that
many parents questioning the effectiveness of vaccines. Also, the factors like peer influence,
personal beliefs, religion, and environmental factors can affect parent’s decision. In addition,
the researchers also found out that parental vaccine refusal can affect the children’s health and
immune system which can greatly expose them to risk of developing vaccine-preventable
diseases. It is also known that the all the participants agreed to mandatory vaccination as a
school requirement.
Conclusions
Based from the data gathered, the researchers therefore conclude that there are many
reasons as to why parental vaccine refusal is present and these are religion reasons, personal
beliefs, safety concerns, and environmental factors. These can contribute to vaccine hesitancy
where in parents are hesitating to accept vaccine but still has a tendency to accept it. It is also
shown that because of the dengvaxia issue and the recent measles outbreak is the reason why
parents are not taking vaccination for their children. The researchers also concluded that
mandatory vaccination as a school requirement is a must. In addition, parents should vaccinate
their children with booster vaccine because it can improve a child’s general health and immune
system. This can do good to a child’s future and it is for the better. Furthermore, ever since
birth it is a protocol to vaccinate a children because it is for improving the health and immune
system of a baby. Last is from the data gathered from the participants, it is proven that vaccine
is really an effective tool against vaccine-preventable diseases.
Recommendations
In this study, the proponents recommend that more time frame should be needed in
order to conduct the study and the future researchers that would like to continue the study
should do a quantitative approach and they should do it in the standpoint and point of view of
parents. The researchers also recommend that if the future researchers continue this in a
qualitative approach, they should have more participants to make the study more reliable and
rigorous. It is also recommended to make an action research regarding this study.
The researchers would like to recommend to parents that are refusing vaccination for
their children that they should still accept vaccination for their children in spite of their trust
issue and safety concerns because it is proved that vaccination is the most effective tool in
order to prevent certain diseases.

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APPENDIX A
Interview Questions:
6.) What are your experiences as a health worker that you think affected parent’s decision
in vaccinating their own children?
7.) Why do you think parents are refusing vaccination for their children? Do you think
that factors like peer influence, personal reasons, religion, tradition, and
environmental factors can affect their decision to vaccinate their children? If so, why?
8.) What can be the clinical impact of parents refusing vaccination for children?
9.) As a health worker, what can you do to prevent this kind of situation? Do you think it
is necessary for mandatory vaccination for children as a school requirement?
10.) Any advice that you can give to the parents who are refusing vaccination for
their children?
Approved by:
Mr. Aegean Ramirez

Research Adviser
APPENDIX B
TRANSCRIPT OF INTERVIEW
Name: Participant A
Age: 44 years old
Years in Service: 7 years
Interviewer: Good morning po, may kaunting katanungan lang po kami para sa gagawin
naming research.
Participant A: Okay, Sige
Interviewer: Experiences nyo as a health worker na sa tingin nyo po nakaapekto sa desisyon

ng mga parents na hindi sila nagpapabakuna ng kanilang anak?
Participant A: Experience sa ngayon yung dengvaxia hanggang ngayon naano pa rin sila sa
mga injection hindi dengvaxia kasi inano na nila ang pangkalahatang group kaya tuloy pag
nag booster kami kagaya nang sa tigdas parang nag-aalangan sila magpabakuna kasi dahil
dun sa isyu na dengvaxia.
Interviewer: Kumbaga parang generalize na po nila yung dengvaxia
Participant A: kahit na yearly nagpapabakuna na kami ganun pa rin
Interviewer: Pero sa tingin nyo po ba yung mga peer influence, personal reasons po nila tsaka
religion po nakakaapekto sa desisyon nila?
Participant A: Hindi naman kasi may mga muslim, iglesia kahit ano yan relihiyon
nagpapabakuna pa rin naman sila pero yung iba talaga dahil nga sa paniniwala nila na di
epektibo yung pagpapabakuna ayun di na sila nagpabakuna.
Interviewer: Pero sa tingin nyo po ba maapektuhan nito yung kalusugan ng bata?
Participant A: Oo naman kasi kailangan natin ng bakuna eh at sobrang maapektuhan talaga

yung kalusugan ng bata kasi nga di siya nagpabakuna at ito yung magiging dahilan kung
bakit mas lalong nagkakasakit yung bata ng mga sakit na kayang maiwasan dahil sa bakuna.
Interviewer: Eh bilang health worker what can you do to prevent this kind of situation?
Participant A: Encourage saka pagbibigay ng lecture sa barangay para mas maunawaan nila.
Interviewer: Sa tingin nyo po ba kailangan sa pilipinas yung mandatory vaccination as a

school requirement?
Participant A: Oo naman
Interviewer: Any advice that you can give to parents na hindi nagpapabakuna ng anak po nila.
Participant A: Ano lang yun pagka sa information dissemination pag hindi mo

napabakunahan yung anak, katulad sa tigdas sa sampung batang binakunahan sa lugar nyo
yung isa pag hindi nababakunahan at nagkaroon ng tigdas yun lang ang mamatay kaya
talagang kailangan na kailangan ng bakuna.
Interviewer: yun lang po, thank you po.
Name: Participant B
Age: 65 years old
Interviewer: Good morning po.
Participant B: Nagtatrabaho sa barangay health worker ng V. Fuguso Health Center. 30 years

na ako in service sa katotohanan ako na yung pinaka matanda dito lahat na napalitan ako
nalang ang hindi.
Interviewer: What are your experiences as health worker that you think affected parents
decision in vaccinating their own children?
Participant B: Actually, hindi kami bilang barangay health worker ang trabaho namin kami
bilang brgy. health worker ang trabaho namin kami lang ang nag iinterview ng pasyente
kapag dumadating dito sa admission tapos kami yung lumalabas, usually ang pinaka job
talaga namin sa labas ng brgy. Kasi brgy. health worker kami ang pinaka ano namin sa mga
brgy. Ngayon yung sakop namin na brgy. eto nga yung fuguso actually 18 brgy. ang sakop
namin zone 34, 35, 36 so pag lumalabas kami yun talaga ang ano namin parang kami yung
leads kami yung mga serbisyo ng health worker binababa namin eto sa mga brgy. Inaano
namin yung mga chairman mga kagawad meron kami halimbawa libreng bakuna sasabihin
namin yun sa brgy. Chairman mag cocoordinate muna kami na meron kaming bakuna ng
ganito na libre sa health center serbisyo din prenatal, dental lahat ng libre sinasabi namin yan
sa brgy. Kung baga kami yung nag bababa ng serbisyo para malaman ng mga constituents’ ng
mga brgy. Na meron ganun serbisyo ng binigay ng health center. Kung ang tanong mo dyan
sa pagbabakuna kung ano ang experience namin hindi kami ano wala kaming capacity para
magbakuna kasi hindi kami nurses hindi namin pinag-aralan yun. Kaya ang tanong mo na yan
sa pagbabakuna nurse ang makakasagot dyan hindi kaming brgy. worker.
Interviewer: As a health worker ano po yung mga experiences niyo?
Participant B: Actually, naman tinatanggap nila yan eto lang mga late yung nagkaron tayo ng
tungkol sa dengvaxia kaya sila natakot pero mulat sapul mula tayo nung mga bata pa kami
may mga bakuna na talaga at saka hindi sila apektado talagang pinapabakunahan nila yung
mga anak nila kasi alam naman nila mulat sapul ang bakuna pagkapanganak ng bata mula pa
naman nagbubutis yan pagpunta nila dito inaadvice na sila na pagnanganak sila ganito
papabakunahan. Ano nga eh pagkalabas ng bata diba BCG na agad yun nilalagyan agad ng
hepagon talagang ano nga yon kumbaga yun na talaga ang patakaran ng hospital na
pagkapanganak babakunahan na agad ang bata wala naman nanay na nagrerefuse na
pabakunahan sila kasi kailangan talaga.
Interviewer: Pero sa tingin nyo po ba peer influence, personal reasons, religion, traditions and
environmental factors ay nakakaapekto pa sa desisyon?
Participant B: Oo totoo yun kagaya ng mga muslim yung iba ayaw talaga na
pinababakunahan yung bata kasi nga against sa religion nila yun ganun talaga kinaugalian na
yun na meron talagang ganun pero sa ating mga catholic saka millennials na ngayon eh
talagan level up na diba pag talagang ipinanganak ang bata pinapabakunahan na talaga alam
na nila yun meron na sila kumbaga alam na nila yan ang pagpapabakuna sa bata ay kailangan
gawin.
Interviewer: Sa tingin nyo po ba makakaapekto ba sa kalusugan sa bata yung hindi

pagpapabakuna?
Participant B: Malaki kasi ang unang binibigay pagkalabas yung which is kailangan ngayon
against all illness yun e para meron na siyang preteksyon pagkalabas niya sa mundo kasi
nung nasa loob siya wala e pagkalabas niya diba bigla nagbabago yung ano, apektado talaga
baby pag hindi napabakunahan, kaya kailangang pabakunahan siya.
Interviewer: So as health worker po what can you do to prevent this kind of situation?
Participant B: Sa totoo lang naglelecture kami e nagbigay kami ng ISC Materials talagang
nagaano kami sa barangay minsan may mga kasama kaming hepo yan mga nurse namin kung
may bagong programa ang manila health deparment o ang department of health inaano namin
yan tinuturo talaga namin yun, nagbibigay kami ng flyers mga ganun para aware sila.
Interviewer: Do you think it is nessesary for mandatory vaccination for children as a school
requirement?
Participant B: Oo lalo na ngayon meron tayong yung human papilloma virus or ano ng
cervical cancer actually first week ng April magkakaron kami ng bakuna sa cervical cancer
mula age ng 9 years old hanggang 13 years old na babae libre yon sa lahat ng health center
starting April 1 for the whole month of April meron kaming bagong bakuna yong cervical
cancer vaccine to 9 years old hanggang 13 years old lang ang pwedeng bakuna.
Interviewer: So last question po any advice that you can give to the parents na hindi nya po
yun nga po dahil sa paniniwala nila na hindi…
Participant B: Hindi nila dapat pabakunahan?
Interviewer: Opo
Participant B: yun nga nagpupunta kami sa kanila nag lelecture kami actually nagpatawag
kami lahat ng chairman para nga dito sa cervical cancer vaccine kailangan sabihan nila sa
barangay nila na ganitong edad meron nang libre ngayon na cervical cancer vaccine kasi pag
sa private mo yan mahal kasi pero ngayon nagbigay nga actually ano yon St. Francis French
siya na kumbaga na private sya.
Interviewer: Sa pagkakaalam ko po ay libo yung cervical cancer vaccine
Participant B: 6-7 Thousand isang injection kaya lang ito two douses pag naginject sila
ngayon ng April babalik sila for the second douse ng September at libre yan ibibgay ngayon
sa health center.
Interviewer: Yun lang po thank you po.
Name: Participant C
Age: 42 years old
Interviewer: magandang umaga po,may mga katanungan lamang po kami sa inyo
Participant C: sige ano yun?
Interviewer: ano pong pangalan niyo, edad at ilang taon na po kayo sa serbisyo?
Participant C: Good morning din, 42 years old at 5 years na kong nagtatrabaho dito bilang
health worker.
Interviewer: what are your experiences as health worker that you think affected parents
Participant C: Actually, lagi naman nagpapabakuna ang mga bata kasama ang kanilang mga
magulang, yun nga lang dahil sa issue about sa dengvaxia nagkaroon sila ng pag-aalangan na
magpabakuna ulit.
Interviewer: Sa tingin niyo po factors like peer influence, personal reasons, religion, tradition,
and environmental factors can affect their decision to vaccinate their children? Sa tingin niyo
po bakit?
Participant C: oo nakaaapekto yun dahil minsan dahil sa kanilang relihiyon kaya ganun
katulad ng sinabi ng mga kasamahan ko ung sa Muslim dahil nga sa relihiyon nila.
Interviewer: Sa tingin niyo po ba may epekto sa kalusugan ng bata kung hindi sila
mapabakunahan?
Participant C: May epekto yun kasi kelangan talaga ng bata ang bakuna para maprotektahan
siya sa mga diseases.
Interviewer: Bilang health worker po, ano po yung ginagawa niyo to prevent this kind of
situation?
Participant C: Ang ginagawa namin ay nagbabahay bahay talaga ng sa ganun ay aware sila
lalo na kapag may mga libreng bakuna ang DOH at nagkakaroon ng mga information
campaign sa barangay.
Interviewer: Sa tingin nyo po ba kailangan sa pilipinas yung mandatory vaccination as a

school requirement?
Participant C: oo naman kailangan yun.
Interviewer: Any advice po na mabibigay niyo sa parents na nagrerefuse na pabakunahan ang

kanilang mga anak?
Participant C: ano lang isipan nilang para sa ikabubuti iyon ng bata at makinig sa mga
campaign or lectures ng barangay about sa vaccination ng mga bata.
Interviewer: Yun lang po, salamat po.
Name: Participant D
Age: 25 years old
Interviewer: Magandang umaga po sa inyo
Participant D: Magandang umaga, nagtatrabaho din ako as a health worker dito sa V. Fuguso
Health Center and 10 years palang ako nagtatrabaho dito
Interviewer: What are your experiences as a health worker that you think affected parents
Participant D: Dahil din siguro sa issue nung mga nakaraan lang like measles outbreak and
dengvaxia pero hindi naman sila naapektuhan ng sobra kase kailangan talaga ng mga anak
nila magkabakuna kase simula bata palang required nang magpabakuna aag mga anak nila.
Sa hospital palang pinapaalala na ng mga Doctor sa mga nanay pinagbubuntis palang nila
yung bata.
Interviewer: Pero sa tingin niyo po ba peer influence, personal reasons, religion,traditions and
environmental factors ay nakakaapekto pa sa pagdedesisyon nila?
Participant D: May mga ganung religion dito sa bansa natin pero most of the time mas
nananaig padin yung kagustuhan nila magpabakuna syempre madaming Catholic and mga iba
pang religion na hindi naniniwala sa ganon. Pero yung mga muslim yung iba talaga sa kanila
nagpapabakuna yung iba ayaw dahil sa paniniwala nila kase against sa religion nila yon at
kinaugalian na nila.
Interviewer: Sa tingin niyo po ba makakaapekto ba sa kalusugan ng bata yung hind nila

pagpapabakuna?
Participant D: Apektado talaga yung mga batang walang kamuwang muwang pag hindi sila
nabakunahan. Kailangan nila magpabakuna para iwas na din sa sakit. Pagkasilang palang sa
kanya may proteksyon na agad yung bata
Interviewer: As a health worker, ano po magagawa niyo to prevent this kind of situation?
Participant D: Naglilibot kame sa barangay na inassign samin then namimigay kame flyers.
Binibigyan namin sila ng ganon para aware sila.Nangangatok kami sa mga bahay bahay na
nasasakupan namin tas tatanungin namin if complete ba sa vaccine yung anak nila, and pag
hindi pa babakunahan ng nurse na kasama namin yung bata kung ano yung kulang.
Interviewer: Sa tingin niyo po ba kailangan sa bansa natin yung mandatory vaccination as a

school rrequirements?
Participant D: Yes, kailangan natin yon
Interviewer: Last po, any advice mabibigay niyo sa parents na nagrerefuse na ipavaccine
yung kanilang anak?
Participant D: Isipin nalang yung mas ikabubuti sa bata tsaka kung gusto niyong hindi
magkasakit ang anak niyo ipabakuna niyo sila. Para din to sa magandang kinabukasan nila
and maging healthy sila
Interviewer: Ayun lang po, Maraming salamat po.
APPENDIX C
CONSENT FORM
Informed Consent Form
The informed consent form must have two sections: an information sheet about the project and a
consent statement. SSERB developed the template below to specify which information must be
included in the form.
Project Title
Poison or Prevention: Perceptions of Health Workers on Parental Vaccine Refusal in the

Philippines
Researchers’ names
Khayie Nicole M. Isidro
First Last
Daphne Mae Roja
First Last
Kenji D. Abao
First Last
Kresh Dhairyll P. Jacobe
First Last
Dave Kyle A. Longara
First Last
Caselyn N. Robiños
First Last
Melody M. Villar
First Last
Arthur V. Dela Cruz
First Last
Address
1208-G Quiricada St. Tondo, Manila
Address Line 1
Phone Email
09665336977 sir_jecht15@yahoo.com
Funding source/sponsor
Parents
Purpose of the study, research methods, and nature and extent of involvement of the research
participants
Primarily, the purpose of this study is put the issue of Parental Vaccine Refusal in the
Philippines due to the fact that the number of parents that are refusing vaccination of their
own children are affecting their children’s health and immune system which will affect the
community that a child belongs in and the child may develop a high risk of being exposed to
vaccine-preventable disease.
Given the qualitative nature of this study, the researchers will be conducting an in-depth and
semi-structured interview with the respondents of the study. Concerning the selection of
respondents, the researchers have employed a snowball sampling technique as it was a more
convenient sampling method for the nature of this study. The respondents who will be
interviewed must have the following characteristics: Firstly, they must be health workers. Next
is that they must be 28-45 years old by the time of the interview, and lastly, the participants
must have an experience on vaccinating children. Selected respondents must answer the
questions asked by the researcher with honesty, sincerity and integrity.
Statement on risks and inconveniencies
The researchers ensure that this study would not be detrimental on the part of the respondents
rather, this would give them opportunity to give concrete answers to make this study
successful. Furthermore, the researchers underwent through the procedures in which a letter
of consent is being prepared for the respondents.
Statement on voluntariness of participation, freedom from coercion and inducement, freedom

to withdraw at any point in the research
The researchers voluntarily participate in the conduct of this research/study. The respondents
may not answer the questions which are personal. They may choose to omit those personal
questions and by not answering to some of these questions will not affect the relationship of
the researchers and respondents.
Statement on the protection of confidentiality, privacy and anonymity of participants during
and after the data gathering stages
The answers of the respondents will be kept confidential, however, if there is a need to publish
this study, the researchers assure that the respondents personal information will not be divulge
for their protection.
(e.g. management of audio or video recording, photos, transcripts and other data from the
participants)
Statement on benefits for the participants
The results of this study would benefit the researchers for the reason that these would solve
the problem being studied of.
Statement on compensation, emoluments and financial considerations (if applicable)
All expenses would be incurred during the conduct of this study shall be shouldered by the
researchers and no fees shall be collected from the respondents.
(e.g. reimbursement of travel, meal expenses)
Statement guaranteeing opportunities for participants to ask questions and express concerns
The researchers are Isidro, K. N., Roja, D. M., Abao, K., Longara, D. K., Robiños C., Jacobe, K. D.,
Villar, M., and Dela Cruz A. with Sir Aegean Paul Ramirez as their adviser. If there are inquiries
you may contact the researchers through their contact numbers indicated above.
Statement indicating arrangements for special cases
The researchers consider that the procedures that would address respondents with special
needs are being strictly complied with.
(e.g. special provisions for minors, availability of legal representatives or psychologists if

needed)
Contact person knowledgeable about the research and the rights of the participants
The researchers and their advisers are responsible for this research.
CONSENT STATEMENT
I am willing to participate in this study entitled Poison or Prevention: Perceptions of Health

Workers on Parental Vaccine Refusal in the Philippines. I have fully understood what this
undertaking will entail. The researcher has explained to me its purpose and objectives, the
method/s of getting data, the extent of my participation as well as remunerationand other
benefits that I will derive from my involvement.
I have not been forced or involuntarily induced to be involved in the study. I am aware that I can
freely withdraw my involvement whenever I wish.
Name and signature of research participant Date
*For those who cannot read and/or sign the form
To show proof that the process was clearly explained by the researchers.
Name and signature of witness Date
Name and signature of principle researcher(s) Date
Name and signature of thesis adviser Date

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PERPETUAL HELP COLLEGE OF MANILA

1240 V. Concepcion Street., Sampaloc, Manila 1008

POISON OR PREVENTION: PERCEPTIONS OF HEALTH WORKERS ON

IN PARTIAL FULFILMENT OF THE REQUIREMENTS

SCIENCE, TECHNOLOGY, ENGINEERING AND MATHEMATICS

Senior High School - JONELTA

Perpetual Help College of Manila

Circle one or more concerns: I, P, C

Available only after consultation with author/thesis adviser Yes, No

Available only to those bound by confidentiality agreement Yes, No

Signature of Thesis adviser

Department – Senior High School, is hereby accepted.

AEGEAN PAUL RAMIREZ

Senior High School.

MARIVIC TANEDO, MA.Ed.

Dear Dean Tañedo,

requirements for the Basic Education Department – Senior High School.

AEGEAN PAUL RAMIREZ

Approved by the Panel of Examiners at the Oral Examination held on

_________________________ with a grade of _____________________________.

AEGEAN PAUL RAMIREZ

MARIVIC D. TAÑEDO, MA.Ed.

Khayie Nicole M. Isidro Dave Kyle A. Longara

Kenji D. Abao Caselyn N. Robiños

Arthur V. Dela Cruz Daphne Mae A. Roja

Kresh Dhairyll P. Jacobe Melody M. Villar

Name : Kenji D. Abao

Name : Arthur V. Dela Cruz

Damulog Central Elementary School

Name : Kresh Dhairyll P. Jacobe

Name : Caselyn N. Robiños

Abundant Life School of Discovery

Name : Melody M. Villar

big role to fulfil this study.

This study would not be possible without them.

extra consideration with regards to time and money.

research in this study.

BACKGROUND OF THE STUDY

effective prevention tool in the medicine field.

immunization decisions for their children.

that such illnesses are eradicated.

STATEMENT OF THE PROBLEM

workers about parental vaccine refusal for their children.

This study also aims to answer the following questions:

vaccines for their child?

2) What are the negative effects of parental vaccine refusal?

4) What can they (health workers) do to prevent this kind of situation?

OBJECTIVES OF THE STUDY

The aim of the study also involves the following:

vaccines for their child.

2) To know the negative effects of parental vaccine refusal.

3) To give advice to parents refusing vaccination for their children.

SIGNIFICANCE OF THE STUDY

is present in the Philippines.

take vaccinations for their children.

comprehend the situation when they refuse the take of vaccines.

a secondary data for their study.

action towards a certain thing.

are cognitive (personal) factors, environmental factors, and behavioral factors.

Religion Personal Safety Desire for Environmental

of this issue are health workers, parents, children, and community.

SCOPE AND LIMITATIONS

the medical field such as nurses, doctors, and etc.

_ with a grade of _____.